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Updated: Aug 14, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
[Cholesteatoma recurrences caused by intraoperative cell seeding? Contact endoscopic and cytologic studies]
1Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Halschirurgie "Otto Körner" der Universität Rostock, Germany.
Background:
The high rate of recurrences of cholesteatomas after surgery is mostly caused by insufficient removal of matrix. Another factor may be intraoperative scattering of matrix cells e. g. with the running burr, which later may become the origin of new cholesteatoma growth. In this paper we tried to visualize these cells for gaining further informations.
Patients And Methods:
In 10 patients intraoperative contact endoscopy of the cholesteatoma was carried out during mastoidectomy. After intravital staining with methylene blue the very superficial tissue layers can directly be considered via a contacting endoscope. In addition, sucked-off rinsing fluid was cytologically examined for epithelial cells.
Results:
Both investigations show only very rare vital squamous cells - besides other cells like or ciliated cells and foreign body giant cells.
Discussion And Conclusions:
Inspite of their small number, these squamous cells in principle could cause dispersed growth of cholesteatoma. However, this seems to be much less significant than the assumption of matrix left behind intraoperatively. The danger of dispersed cell growth can further be diminished by adequate operating techniques with sufficient rinsing, smoothing the bony cavity walls and avoiding blind corners.
Insights
Recurrent cholesteatoma is often due to residual matrix. This study found few vital squamous cells dispersed during surgery, suggesting residual matrix is a greater concern for cholesteatoma recurrence.
Area of Science:
- Otolaryngology
- Surgical Pathology
Context:
- Cholesteatoma recurrence after surgery is a significant clinical challenge.
- Incomplete matrix removal and intraoperative cell dissemination are suspected causes.
Purpose:
- To visualize and quantify dispersed cholesteatoma matrix cells during surgery.
- To assess the contribution of dispersed cells to cholesteatoma recurrence.
Summary:
- Intraoperative contact endoscopy and cytology of rinsing fluid were performed in 10 patients undergoing mastoidectomy for cholesteatoma.
- Both methods revealed rare vital squamous cells, alongside other cell types.
Impact:
- While dispersed cells are viable, residual matrix is likely a more significant factor in cholesteatoma recurrence.
- Optimized surgical techniques, including thorough rinsing and cavity smoothing, can minimize the risk of recurrence.
